RSNA News - December 2004

RSNA Visiting Professors Share Experiences with Argentine Radiologists

They have a CT scanner that has not been used for two years since the tube burned out. A new tube would need to be imported and the hospital is dependent on public funds, so they cannot afford to get another one.
— Gia DeAngelis, M.D.

Argentina often conjures up visions of the tango, gauchos or Eva Peron. But after participating in this year's RSNA International Visiting Professor (IVP) Program and seeing the country firsthand, three RSNA members will remember other images.

"As we were leaving for the airport, we saw families having picnics on the median strips of the highway to enjoy what greenery there was in the city," says Theodore Dubinsky, M.D., one of three visiting professors who attended the 50th Argentine Congress of Radiology in Buenos Aires this September. The team saw both the beauty of South America's second largest nation as well as the devastating impact Argentina's economic crisis has had on its citizens and their healthcare.

RSNA's three International Visiting Professors to Argentina are pictured with Sociedad Argentina de Radiologica (SAR) President Ricardo García Mónaco at the 50th Argentine Congress of Radiology in Buenos Aires. (from left to right) . William Brant, M.D., Gia DeAngelis, M.D., Theodore Dubinsky, M.D., and Professor García Mónaco.

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Dr. Dubinsky is an associate professor of radiology at the University of Washington School of Medicine, and serves as director of the Body Imaging Center at Harborview Medical Center in Seattle. The team also included William Brant, M.D., a professor and acting chairman of the Department of Radiology at the University of Virginia, Charlottesville, and Gia DeAngelis, M.D., an associate professor of clinical radiology at the University of Virginia. The IVP Program allows small teams of imaging professionals to lecture at the national radiology meeting of emerging nations, as well as at the host institution.

All three physicians attending the congress made presentations to well-attended sessions. "Overall, my impression is of wonderful people and, for the most part, the physicians are very well-trained. But they are being challenged by their economy," says Dr. Dubinsky. "Costs are difficult to manage and their equipment is not as up to date as ours."

The Argentine economy collapsed in December 2001. After several days of violent street protests that left 27 people dead, Argentine President Fernando de la Rúa resigned and a state of emergency was declared. The value of the peso plummeted and has stayed low while unemployment and poverty have increased. For the medical community, the impact has meant less of everything—training, equipment and space to perform exams and medical tests.

Dr. Dubinsky says the state of the economy was a popular topic of conversation at the congress, noting that some physicians fear their perceived wealth makes them targets for criminals. "I heard one story of a doctor's child being held at gunpoint while he and his family were forced to drive to a bank and withdraw money," he says. "The child and his parents escaped unharmed when the robbers ran off with the cash."

Despite the uncertain economic climate, Argentine physicians warmly welcomed the RSNA contingent and treated them very well. "It's an honor being a visiting professor representing RSNA," says Dr. Brant.

In return, Drs. Dubinsky, Brant and DeAngelis say they worked hard during their visit, doing extra lectures, teaching conferences and making hospital visits to regions outside the meeting site in Buenos Aires. Dr. Brant's host took him around the city of Mendoza, near the Andes Mountains, to medical facilities at the National University of Cuyo.

In the region's central hospital, he saw how physicians and students cope with a lack of sufficient medical funding and outdated equipment. "It's like seeing a county or public hospital here. There are large numbers of ill, indigent patients, but the situation is magnified " Dr. Brant says.

He saw radiology residents act as technicians, performing ultrasounds and other scans, but Dr. Brant says that may have had a positive effect on patient care. "The tests were tailored to the patient's problem and the resident was right there to make a decision," he explains. "The quality of the equipment is some generations behind what we have. For instance, they're using single-slice CT units but the quality of the studies was high. They push the scanner for quality."

At the region's central hospital, thousands of patients are seen each year in the one room where fluoroscopy studies can be done. Dr. DeAngelis found similar conditions at a public hospital in Cordoba, a major city outside of Buenos Aires.

"They have a CT scanner that has not been used for two years since the tube burned out. A new tube would need to be imported and the hospital is dependent on public funds, so they cannot afford to get another one," she says. "The radiologists have to make do. They perform angiography with equipment that had been dedicated to cardiac imaging and adapt their technique to obtain high-quality images."

A physician surplus in Argentina has created a fierce competition for medical residency spots—especially in the better-equipped private practices. "There are only about 500 paid medical residency opportunities for approximately 8,000 graduates a year," says Dr. Brant. "There are about 1,000 more unpaid residency slots. So residents in the unpaid programs compete for the chance to take night call for extra money."

Because the value of the Argentine peso is so low, only a few wealthy students can go abroad for training. While most of the faculty at medical schools is devoted to training young physicians, the professional surplus with the concurrent lack of adequate specialty training could make some physicians reluctant to train residents for fear of the competition.

"Ultimately, some patients have less access to medical treatment," says Dr. DeAngelis, who adds that part of the solution may be to train more radiologists in subspecialties. "We take so much for granted. One prominent radiologist I met considered it one of the highlights of her career to get a poster accepted at the RSNA annual meeting. They're so appreciative when they receive an accolade from a radiology society or have a chance to speak or be published."

As part of the IVP Program, RSNA's Committee on International Relations and Education provides for donation of educational materials to the host institutions.

Also this fall, an IVP team visited Romania, and in a separate but similar program, a team of visiting professors traveled to Mexico City.

Next year, IVP teams will go to Brazil, Thailand and Sri Lanka. Dr. Brant says it's important for U.S. radiologists to play a role as international teachers. "RSNA is very highly respected in Argentina. Physicians look at it as the standard of where radiology is going," he says.

The 2004 RSNA IVP program was funded through an endowment from the Agfa Corporation. In 2005, the IVP program will be funded through endowments from Agfa and FUJIFILM Medical Systems.